key: cord-0772142-qypq7rit
authors: Marotta, Serese; McNally, Veronica Valentine
title: Increasing Vaccine Confidence Through Parent Education and Empowerment Using Clear and Comprehensible Communication
date: 2021-05-03
journal: Acad Pediatr
DOI: 10.1016/j.acap.2021.01.016
sha: 1c68db2078d29c981fdae024f363628c51f3ad0a
doc_id: 772142
cord_uid: qypq7rit

nan

T A G G E D P AS PARENTS, WE all want to protect our children and families. Most parents are vaccinating according to the recommended schedule by the Advisory Committee on Immunization Practices. 1 However, child and adolescent immunization rates continue to be threatened by vaccine hesitancy, putting communities and public health at risk. The World Health Organization named vaccine hesitancythe reluctance or refusal to vaccinate-among its recently released list of 10 global health threats for 2019.

In 2019, the United States had its highest number of measles cases since 1992 and almost lost its measles elimination status. 2 Other vaccine-preventable diseases such as mumps, hepatitis A, pertussis, and influenza (flu) also continue to threaten public health, both nationally and internationally. In 2020, the coronavirus disease 2019 (COVID-19) pandemic substantially disrupted outpatient medical care, which contributed to a decline in childhood immunizations. 3 The COVID-19 pandemic has given us a glimpse of the impact of serious diseases without vaccines. Vaccines have drastically reduced infant deaths and disability caused by preventable disease in the United States. On average every year in the United States, over 100 children lose their lives to flu-related complications. For the 2019 −20 season, 195 flu-related pediatric deaths were reported to the Centers for Disease Control and Prevention and since 2004 when reporting began, over 2000 pediatric flurelated deaths have been reported. 4 Even though flu is a vaccine-preventable disease, generally less than 60% of children are immunized against the flu every season. Especially during national health care crises such as COVID-19, it is critically important to increase vaccination rates for flu and other infectious diseases to decrease health care utilization and protect at-risk populations.

To prevent additional outbreaks of vaccine-preventable diseases and maintain herd immunity, it is imperative that parents vaccinate their children on time, every time. To that end, providers must seek to increase vaccine confidence through parent education and empowerment using clear and comprehensible communication. Research indicates that health care professionals remain by far parents' most trusted source of information (CDC, unpublished data, 2016). A 2013 study by Glanz et al 5 found that although parents trust their pediatricians, many do not trust the information their pediatricians provided about vaccines. Online health information can have a significant effect on parents' attitudes toward vaccination and online vaccine misinformation is pervasive. 6 Outside of exam room discussions, combatting this misinformation proactively at the practice level can include the sharing of evidence-based vaccine information on websites, social media channels, emails/newsletters, and reminder-recall systems. Provider-parent communications should also reinforce that immunizations are a social norm.

Overall, patient education leads to empowerment, reinforcing the notion that a properly informed parent will make good choices when it comes to their child(ren)'s health. About a third of parents who initially refuse a vaccine will change their minds following educational intervention methods. 7 This validates the importance of communication and continued education about the risk of disease and the benefits of vaccination. In every vaccine encounter, providers should employ the presumptive approach, that is, assume the parents will vaccinate the child(ren) according to the Advisory Committee on Immunization Practices schedule and frame it like the routine procedure it is. This approach has been found to increase the odds of vaccination by 17.5%. 8 When providers are confident, parents are more likely to be confident as well.

However, if a parent presents with questions during the vaccine encounter, to have a productive conversation, it is imperative that the provider identify the specific concerns of the parent and address them. Having a conversation with vaccine-hesitant parents should include more than facts and statistics though. Research has shown that highly emotional narratives had a greater impact on vaccine risk perceptions. 9 Vaccination remains an emotionally charged issue for some parents. Therefore, conversations must include an emotional element(s) to address vaccine hesitancy. Storytelling-the sharing of personal stories of diverse individuals who were adversely impacted by a vaccine-preventable disease-appeals to parents' emotions and can be successful in illustrating disease susceptibility and severity so long as it contains relatable content. Stories are 22 times more memorable than statistics. 10 To be effective, these personal stories must be framed in a compassionate, empathic way in an effort to change vaccination behavior.

Parents can contribute to increasing vaccination rates by influencing their peers and highlighting social norms related to immunization. This can be accomplished through efforts such as social media campaigns, 11 involvement with advocacy groups and immunization coalitions, supporting strong immunization policies at the local and/or state level, or simply being vocal with friends, family, and/or community members about why immunization is important to them.

As parents who have lost children to vaccine-preventable diseases, the Families Fighting Flu organization and Franny Strong Foundation advocate for increased awareness about the seriousness of vaccine-preventable diseases and the critical importance of vaccination. Families Fighting Flu is a national, nonprofit organization whose members have lost a loved one to flu or had a loved one suffer serious medical complications as a result of flu. Central to the organization's education and advocacy efforts is the sharing of personal stories of loss and survivorship in an effort to raise awareness about the seriousness of flu, the critical importance of annual flu vaccination, and the value of community immunity. The Franny Strong Foundation is also a national nonprofit organization that honors lives lost to vaccine-preventable diseases. Franny Strong seeks to boost childhood immunization rates for all vaccine-preventable diseases by developing cutting-edge education strategies to help health care professionals and the public learn about vaccinations, including the I Vaccinate Campaign.

We have witnessed firsthand that using storytelling, along with social norming techniques and peer-to-peer influence, on various communication channels has the capacity to change vaccination behavior for parents who are vaccine-hesitant. To assist with bolstering vaccine confidence, Families Fighting Flu (www.familiesfightingflu. org), the Franny Strong Foundation (www.frannystrong. org), and I Vaccinate (www.ivaccinate.org) offer educational resources and content on their websites and social media channels 11 that help support patient conversations with vaccine-hesitant parents.

Vaccine confidence is an issue that both health care providers and parents can help bolster through different avenues, and we're hopeful that by working together we can reduce the number of severe health outcomes related to vaccine-preventable diseases.

Financial disclosure: This article was published as part of a supplement sponsored by the Centers for Disease Control and Prevention.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Confidence about vaccines in the United States: understanding parents' perceptions

Measles cases and outbreaks

Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration-United States

Influenza-associated pediatric mortality

A mixed methods study of parental vaccine decision making and parent-provider trust

The online competition between pro-and anti-vaccination views

Childhood immunizations: first time expectant mothers' knowledge, intentions, beliefs, and behaviors

The architecture of providerparent vaccine discussions at health supervision visits

The influence of narrative v. statistical information on perceiving vaccination risks. Med Decis Making

A good presentation is about data and story. Forbes

Social media campaigns can involve engaging with existing content from advocacy organizations like Families Fighting Flu and I Vaccinate (a Franny Strong Foundation initiative)